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The authors describe a 16-year-old boy, previously healthy, who was admitted to our hospital for left-sided spontaneous pneumothorax. On physical examination he presented with marfanoid habitus. Pneumothorax was managed conservatively with resolution. Four months later he had a recurrence of left-sided pneumothorax and 1 week after that he presented with contralateral pneumothorax. He underwent video-assisted thoracoscopic surgery twice for bullectomy and pleurodesis. No further recurrence was stated. Additional investigation showed a prolapsed cardiac mitral valve and Marfan syndrome was confirmed genetically.

Background: Meningitis is an uncommon clinical manifestation of invasive infection by Streptococcus pyogenes., Case Report: A four years-old female child, previously healthy, started a history of high fever, associated to right otorrhea, prostration and vomiting. On admission she was haemodynamically stable but prostrated, with stiff neck and right otorrhea. Laboratory evaluation showed leukocytosis with neutrophilia, thrombocytosis and high C-reactive protein. The cerebrospinal fluid (CSF) examination suggested bacterial meningitis and treatment with ceftriaxone was started. After Streptococcus pyogenes grew in the CSF, clindamycin was added. She completed 15 days of antibiotics and was discharged clinically recovered. No neurological or hearing sequelae were observed., Conclusions: Although the incidence of group A streptococcal meningitis seems to be low, invasive infection by this agent is raising. Despite the excellent evolution of this case, a fatal outcome or neurological sequelae can arise, even in healthy children.

A retrospective study was made of 6 children, with nonsurgical-related acute myocardial infarction (AMI), between January 1987 and December 1994. The ratio for gender was 1 and mean age at AMI was 49 days, 4 cases being associated with congenital heart disease (Fallot's tetralogy, truncus arteriosus and DiGeorge syndrome, one case each, and anomalous origin of left coronary artery, 2 cases). Kawasaki disease and coronary embolisation from thrombosis of the renal vein occurred in the other 2 cases respectively. All developed congestive cardiac failure and cardiomegaly. In the ECG pathologic q waves with more than 35 msec occurred in all, and QT prolongation occurred in 3. Five children (83%) all with AMI in the anterior and lateral wall of the left ventricle died, death being related with cardiac mechanical failure and not with arrhythmias.